2017 New Grad Edition - 32

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Tom Mitchell
Member Since: 02/16/04
Post: 45 of 86

Many years ago when I was a student, we weren't allowed to do any crowns on patients who
did not have excellent home care and controlled perio. Made us nuts because we were trying
to get our requirements done. Ever since then, I don't do crowns on patients who don't have
excellent hygiene and controlled perio; I've been doing composites only-yes, I know all about
amalgam being a great material-until the environment is stable. Most of the composites have
not needed replacing for any reason. ■

6/27/2017

Bald Eagle
Member Since: 12/07/07
Post: 49 of 86

If the D.O. "gets profound recurrent decay again," wouldn't a crown as well? A crown doesn't
increase a person's resistance to caries; more likely, the opposite happens. Side note: I wouldn't
call this a large D.O. but a deep one.
I restore a D.O. like this every day and it doesn't cross my mind to crown it. Why would an
RCT change things? ■

6/27/2017

orangedoc
Member Since: 09/15/10
Post: 50 of 86

Are you saying a root canal doesn't change things? Have you ever crowned an RCT molar
that had deep occlusal decay but pristine interproximals? Do you crown every tooth with deep
occlusal decay? If yes, then no, why did you crown the RCT tooth? ■

6/27/2017

John Kanca
Member Since: 06/21/03
Post: 51 of 86

orangedoc
Member Since: 09/15/10
Post: 55 of 86

It's not about the enamel. It's all about the dentin. ■

6/27/2017

Well, I'm no endodontist, but I've yet to see a root canal that was limited to removal of
enamel. Hence, a question like "Why would a root canal change things?" doesn't make a whole
lot of sense. A root canal certainly changes things and must be factored into treatment planning
for any tooth. Whether it changes things enough for this particular tooth to warrant an indirect
restoration is still up for debate, but it's a critical factor in making that decision. ■

6/28/2017

John Kanca
Member Since: 06/21/03
Post: 56 of 86

Obviously you can do whatever you want, but in my opinion a crown is a waste of money
unless this patient comes around. I think the direct restoration is money better spent, especially
because of the overall situation. Doing the endo is offering a chance to make things better. And as
I think was already said, more can be done if the yearly benefits aren't blown out on one tooth. ■
6/28/2017

orangedoc
Member Since: 09/15/10
Post: 57 of 86

If you want to start treatment planning based on available funds, that's another matter. If
money was limited, I'd definitely focus on caries control throughout the mouth and do a really
good buildup or a temp crown for the RCT premolar.
My comment was just pertaining to the root canal changing things. I can't see how you don't
at least factor in the tooth having had a root canal into your treatment planning. ■
6/28/2017

Matty L
Member Since: 03/02/14
Post: 58 of 86

Wow! I was away for a few days, but am floored at all the responses and tips given. Thank
you to all who have chimed in! The patient had not seen a dentist in over two years and while she
says she brushes twice a day and flosses at night, I have a hard time seeing that. She did admit to
a sweet tooth, especially for chewy candies that are allowed to sit on the teeth. We have discussed
that at length and it hopefully won't be happening anymore.
All restorative treatment has been completed and we are waiting on her insurance pre-D for
the crown. However, I am leaning to the same side as Dr. Kanca and others in recommending

NEW GRAD 2017 // dentaltown.com

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